At least 100 million COVID-19 vaccines sent to poorer nations had to be turned away last month — not because the countries didn’t want them, though, according to a UNICEF official.
Rather, richer nations delivered the vaccines too close to their expiration dates and in numbers too large for the recipient nations to store them, Etleva Kadilli, director of Supply Division at U.N. agency UNICEF, told lawmakers at the European Parliament on Thursday.
“More than 100 million have been rejected just in December alone,” Kadilli said, according to Reuters.
But public health experts and bioethicists say getting the world vaccinated is the key to avoiding the creation of new variants. So what happened with these doses, and how do we make sure it doesn’t happen again?
Near-expired COVID-19 doses delivered
The doses wealthy nations delivered were close to their expiration, Kadilli told European lawmakers on Thursday, which gave poorer nations less time to get the vaccines into arms.
“If I was delivering a bottle of milk to you every day, and every day and I delivered a bottle of milk to you, you drank that bottle of milk. If one day I showed up, without any warning, with 100 bottles of milk that expired at midnight, you wouldn’t be able to drink them,” said Dr. Peter Singer, an adviser with the WHO, in an interview with Global News.
“And that’s exactly what happened here.”
Kerry Bowman has travelled to Yemen, a country with a 0.5-per cent vaccination rate, twice in the last five months. As issues of vaccine inequality become more and more glaring, he says he’s encountering more people abroad who think Canada is “not forming respectful global partnerships.”
“This is kind of cast off hand-me-down rejects from high-income countries — ‘We’ll give you vaccines we don’t want, that are about to expire,’ as opposed to, ‘We’re going to set up partnerships for the well-being of all of us as human beings,'” Bowman, who is a bioethicist and global health professor at the University of Toronto, said.
The shelf life of the doses isn’t the only issue at hand.
There are a lot of steps that come between the delivery of vaccine doses and the needles actually going into arms, according to Tinglong Dai, a Johns Hopkins University researcher who specializes in health care logistics.
“What it takes to vaccinate people, to put doses into people’s arms, that is actually…way, way harder work,” Dai said.
For example, nations need to have the refrigeration and storage facilities upon arrival, Dai said. Then, they need to be able to transport the vaccines — that means they need people to transport them, trucks, trains or planes, and roads. People need to be able to get to vaccination site, too.
You also need “professionals,” Dai said, to inject vaccines into arms, to perform quality control on the vaccines themselves, and turn the “raw materials” that countries receive into actual vaccines.
Getting “one million doses of vaccine,” Dai said, “doesn’t mean anything unless they have the capability to turn that into actual vaccinations.”
Fixing the COVID-19 vaccine equality problem
One of the main things countries like Canada can do to ensure vaccines don’t go to waste is provide a “predictable supply.”
Canada has committed to sharing 200 million vaccines through the global COVAX vaccine-sharing initiative, and it has delivered almost 100 million of those to date, according to Global Affairs.
Still, the numbers that are distributed can vary wildly from day to day — Bangladesh received 2.2 million doses on Dec. 19 alone, while two days later more than 470,000 doses arrived in Rwanda.
“It’s really important to have predictable supply and not to use bottlenecks in distribution…as an excuse to limit supply,” Singer said.
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Bowman worried that the latest headlines about vaccines remaining unused might impact supply, too.
“One of the first things that concerns me is people say, ‘Well, there’s no point in sending these things to low income countries because they’re not going to be able to deal with them,'” Bowman said.
“That is completely wrong.”
Bottlenecks occur “in every country in the world,” Singer said.
“In Canada, the army is helping to distribute vaccines in Quebec. This is not unique to low- and lower-middle-income countries. Every country has some distribution bottlenecks,” he explained.
Once the supply is secured, richer nations can also help ensure these countries have the capacity to actually roll them out, Dai said.
That can be achieved by sharing research on the vaccines themselves, the global health experts said, as well as through donating supplies like refrigerators, sending over professionals who can assist with distribution, delivery and injection of vaccines, or boosting funding so nations can do it themselves.
It’s a bit like assembling furniture, he said.
“If someone doesn’t have furniture (and) you just deliver them five boxes of IKEA furniture, that may not help them, because not everyone has the capability of assembling IKEA furniture,” Dai explained.
“In this case, it’s like you’re dropping IKEA furniture to someone’s door,” he added, and they “may say no.”
Canada can also help by sharing vaccine research and development — or pushing pharmaceutical companies to waive vaccine patents — Singer added, so countries can make vaccines themselves, within their own borders.
“I think most Canadians probably don’t know that one of the key components of the mRNA vaccine — the lipid nanoparticle, which is actually how the vaccine is delivered — was developed in Canada,” Singer said.
“So Canada has a lot of research and development potential. And as we rebuild our own domestic vaccine manufacturing, we can also work with countries around the world to help them rebuild their domestic manufacturing.”
This, Singer said, will create “a much more resilient future.”
What is Canada already doing?
Canada has been trying to help address vaccine inequity by donating to the global vaccine-sharing initiative, COVAX, according to a spokesperson for Global Affairs Canada.
“Through financial contributions and donated surplus doses, Canada has made 98.8 million doses available to COVAX of the committed 200 million doses,” Patricia Skinner wrote in an emailed statement.
Canada also does its best to ensure doses don’t go to waste, she added.
“No doses sit idle; vaccines are distributed to recipient countries as soon as possible. In exceptional circumstances, Canada may explore other options for donations as necessary, including bilateral donations to avoid wastage,” Skinner said.
The government has also given $70 million to the COVAX Advance Market Commitment, which allows participating countries to apply for funding to support vaccine delivery and distribution within their nation, and partnered with UNICEF to match Canadians’ donations to the #GiveaVax Fund dollar-for-dollar.
“The funds are enabling UNICEF to cover the per-person cost to transport vaccines to destination countries, keep vaccines viable by protecting the cold chain during the journey and train health care workers to effectively administer the vaccines and safely dispose of needles and waste,” Skinner said.
“Thanks to the generous contributions of individual Canadians, the full $19,351,857 (total of donations and match) will cover the costs of vaccinating over 3.8 million people around the world.”
Still, Bowman said Canada needs to step things up in the year ahead.
“Canada has come through with with extra funding for health-care infrastructure, but we now have to come through with with much, much more in the year of 2022,” he said.
It’s an issue Canada is speaking about with other countries around the world, according to a spokesperson for International Development Minister Harjit Sajjan.
“Minister Sajjan has raised vaccine equity and the need to ensure timely delivery of vaccines to the Global South when meeting with his counterparts and partners,” said Todd Lane, Sajjan’s spokesperson.
“We continue to collaborate with COVAX and the global community so that vaccine dose roll-out is done in an equitable and timely manner.”
A selfish and generous solution to COVID-19
Stepping up the fight for global vaccine access isn’t just the ethical thing to do — it’s also a way to ensure Canadians stay safe, according to Bowman.
“If we don’t do this, we’re all going to have a big lesson in the Greek alphabet as these variants keep coming at us,” he said.
The more a virus spreads, the more it replicates — and the higher the likelihood it will make a mistake while replicating, which is a mutation.
Those mutations can sometimes be advantageous for the virus, for example, by making it more transmissible, or teaching it to evade vaccines, according to multiple public health experts. The more COVID-19 spreads, the more replication occurs — and the more chances spring up for a serious mutation to take hold.
“It’s in our interest to vaccinate the world, not only because it saves a ton of lives, but also because it’s a way to help prevent variants,” said Singer.
“And who wants to go through Omicron again?”
— With files from Reuters